This technical report describes the case of a middle-aged female who presents with altered mental status (AMS). This is a common scenario in acute care settings where emergency physicians are frequently required to gather critical information about a patient’s presentation in a time-sensitive manner. Since the patient is unable to inform caregivers about her symptoms and medical history, the physician must use ancillary resources such as chart reviews, collaborative history, and information from emergency medical services (EMS) personnel, and may even need to search the patient’s belongings.
In this simulation, learners will have the opportunity to explore an unusual AMS presentation and develop their clinical and communication skills by working as a team to manage the patient. Learners and physicians in all fields of medicine must be able to confidently discuss these subjects with patients and their families in order to provide individualized and appropriate management. This scenario explores learners' comfort in some less-practiced, but very important, areas of medicine including obtaining consent for treatment from a substitute decision maker (SDM), explaining various goals of care, and eliciting an advanced care directive from the SDM. It allows learners to build confidence by dealing with life-threatening conditions in a safe environment and has been shown to be superior to other forms of clinical training. Simulation-based education (SBE) offers one solution to this challenge.
Emergency physicians frequently are required to perform timely assessments on patients who are unable to provide a comprehensive history due to an altered level of responsiveness. The etiology of their altered mental status (AMS) causes a diagnostic dilemma due to its wide differential diagnosis. Physicians must use a timely combination of collateral history, physical examination skills, and investigations to diagnose the cause of the patient's AMS, as many of the potential etiologies can be life-threatening if not quickly managed.įor this reason, training learners to perform the required actions accurately and effectively proves difficult during real-life emergencies, where an individual's life may be at risk.
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